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Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis
Qiao Chen1, Die Zhao2, Jie Sun1
1The First Central Clinical School, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin 300070, China.
Background:
A comprehensive evaluation of the benefits of mineralocorticoid receptor antagonists (MRA) in acute myocardial infarction (AMI) patients is lacking.
Objective:
To summarize the evidence on the efficacy and safety of MRA in patients admitted for AMI.
Methods:
Articles were identified through PubMed, Embase, Cochrane Library, Ovid (Medline1946-2021), and ClinicalTrials.gov databases from their inception to December 31, 2020.
Results:
15 articles with a total of 11,861 patients were included. MRA reduced the risk of all-cause mortality by 16% (relative ratio (RR): 0.84; 95% confidence interval (CI) (0.76, 0.94); P = 0.002) and the incidence of cardiovascular adverse events by 12% (RR: 0.88, 95% CI (0.83, 0.93), P < 0.00001) in post-AMI patients, and further analysis demonstrated that early administration of MRA within 7 days after AMI resulted in a greater reduction in all-cause mortality (RR: 0.72, 95% CI (0.61, 0.85), P < 0.0001). Subgroup analyses showed that post-STEMI patients without left ventricular systolic dysfunction (LVSD) treated with MRA had a 36% reduction in all-cause mortality (RR: 0.64, 95% CI (0.46, 0.89), P = 0.007) and a 22% reduction in cardiovascular adverse events (RR: 0.78, 95% CI (0.67, 0.91), P = 0.002). Meanwhile, post-STEMI patients without LVSD treated with MRA get significant improvements in left ventricular ejection fraction (mean difference (MD): 2.69, 95% CI (2.44, 2.93), P < 0.00001), left ventricular end-systolic index (MD: -4.52 ml/m2, 95% CI (-8.21, -0.83), P = 0.02), and left ventricular end-diastolic diameter (MD: -0.11 cm, 95% CI (-0.22, 0.00), P = 0.05). The corresponding RR were 1.72 (95% CI (1.43, 2.07), P < 0.00001) for considered common adverse events (hyperkalemia, gynecomastia, and renal dysfunction).
Conclusions:
Our findings suggest that MRA treatment reduces all-cause mortality and cardiovascular adverse events in post-AMI patients, which is more significant in patients after STEMI without LVSD. In addition, MRA treatment may exert beneficial effects on the reversal of cardiac remodeling in patients after STEMI without LVSD.
Insights
Mineralocorticoid receptor antagonists (MRA) significantly reduce mortality and adverse cardiovascular events in acute myocardial infarction (AMI) patients. Early MRA administration and use in STEMI patients without LVSD show enhanced benefits, including improved cardiac remodeling.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- A comprehensive evaluation of mineralocorticoid receptor antagonists (MRA) benefits in acute myocardial infarction (AMI) patients is needed.
- Existing evidence on MRA efficacy and safety in post-AMI patients requires synthesis.
Purpose of the Study:
- To summarize the evidence on the efficacy and safety of MRA in patients admitted for AMI.
- To assess the impact of MRA on mortality, cardiovascular events, and cardiac remodeling post-AMI.
Main Methods:
- Systematic review and meta-analysis of published studies.
- Searched PubMed, Embase, Cochrane Library, Ovid, and ClinicalTrials.gov up to December 31, 2020.
- Included 15 articles encompassing 11,861 patients.
Main Results:
- MRA reduced all-cause mortality by 16% and cardiovascular adverse events by 12% in post-AMI patients.
- Early MRA administration (within 7 days) showed a greater reduction in mortality.
- In STEMI patients without LVSD, MRA significantly reduced mortality, adverse events, and improved cardiac remodeling markers.
Conclusions:
- MRA treatment is effective in reducing mortality and cardiovascular adverse events in post-AMI patients.
- MRA demonstrates particular benefit in STEMI patients without LVSD, including improved cardiac remodeling.
- Further research should explore optimal timing and patient selection for MRA therapy post-AMI.
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